As probably the most recognized medical device in history, the stethoscope is a true symbol of modern medicine that can be found in the bags, offices and hanging from the necks of doctors and nurses around the world; yet it is a technology that has remained largely unchanged since its invention in the early 19th century. As the stethoscope marks its 200th anniversary this year, this cornerstone of modern medicine is getting a digital upgrade – and it is not the only technology that is transforming the traditional doctor’s bag.

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The Eko Core attachment transforms any stethoscope into a digital device, providing a range of technical functions for physicians.
Imaged credit: Eko

The stethoscope was invented in France in 1816 by René Laennec. His device consisted of a simple wooden tube similar to the common ear trumpet, which allowed him to examine the chests of women without having to press his ear to their bodies – the common method of auscultation used by physicians at that time.

It was not until 1851, when Irish physician Arthur Leared invented a binaural stethoscope (that used both ears) – a design that was quickly perfected by George Philip Cammann in 1852 – that the device we all recognize today became a common tool of medicine.

This design has remained a standard of health care technology for so long.

Now, the humble 200-year-old technology is getting a digital upgrade courtesy of medical device startup Eko. Using an innovative attachment called the Eko Core, any standard stethoscope can be transformed into an intuitive digital device that provides physicians with a whole range of technical functions.

Other attempts have been made in the past to introduce digital stethoscopes, but these have traditionally involved replacing the existing technology with a completely new device.

Eko’s approach instead takes a physician’s favored analog stethoscope and transforms it into a powerful digital tool.

Using the device, a patient’s heart sounds can be easily visualized, annotated and integrated with electronic health records, making consultations easier and more effective than ever before.

The technology also enables doctors to easily seek second opinions or comment on a patient’s heart sounds from virtually anywhere using mobile and desktop devices.

“The beauty of the Eko Core is that it captures heart sounds in a streamlined way that has never been done before, interfacing seamlessly into our traditional exam without requiring any extra effort,” says John Chorba, cardiologist at the University of California-San Francisco.

“It’s incredibly challenging to hear a minute heart murmur, especially in patients with high heart rates,” says Eko co-founder Connor Landgraf. “Cardiologists say it’s almost like a musical ear, it’s something that you have to learn over 5 or 10 years of practice.”

With the Eko Core, the physician can see the heartbeat in wave form on a mobile device, as well as hear the sound at an amplified level. Both the visible and audible data can be recorded and easily shared between physicians and hospitals. For doctors, this takes a lot of the guesswork out of detecting murmurs, valve problems and blockages in the arteries.

“Connecting patients to physicians with non-invasive tools to understand what’s going on in peoples’ hearts is going to be really powerful,” Landgraf says. “Right now you can catheterize a patient to find out what the pressures are like inside of the heart, but it’s very invasive and inefficient.”

And it is not only the stethoscope getting the digital treatment. The proliferation of gadgets, apps and web-based information has given clinicians a black bag of new tools: new ways to diagnose symptoms and treat patients, to obtain and share information and to think about what it means to be both a doctor and a patient.

Two other familiar instruments getting the digital treatment are the otoscope and the ophthalmoscope.

Cupris Health, a UK-based company, has developed a CE-marked, patent-pending otoscope that attaches to a smartphone to allow the examination of the eardrum.

The device, which has already been validated in testing with over 50 health care professionals, can capture clinical images of the eardrum, allowing users to add information about cases using questionnaires, audio recordings, text input and other tools built into the smartphone app, as well as securely connect with other users to share and collaborate on cases through a secure cloud service.

The idea came from Julian Hamann, a National Health Service (NHS) consultant surgeon, who felt that a large proportion of his patient consultations could easily be handled remotely, and that this same problem was felt around the world with all specialties.

Not only does this type of solution upgrade traditional technologies by allowing physicians to capture, store and analyze images of individual examinations, but it also decentralizes the need for traditional examinations.

Using these mobile medical devices, it becomes possible to conduct examinations out in the community rather that in the usual settings of a clinic or doctor’s surgery. The technology easily enables remote consultations, saving time and improving efficiency.

Formal trials of the otoscope were due to start in March 2016, supported by funding from the UK NHS. The company has also prototyped a similar ophthalmoscope device attachment that will enable a physician to use a smartphone for retinal imaging.

The whole process of examining patients is changing as a result of new technologies. In the past, referrals for medical imaging like ultrasounds or endoscopic examinations all required significant delays for patients as they awaited appointments with specialists.

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The Lumify from Philips is a portable ultrasound that can be used almost anywhere.
Image credit: Philips

Now, physicians have access to mobile and point-of-care technologies that are fundamentally changing the way that examinations are conducted and diagnoses are given.

Philips recently launched a high-quality, portable ultrasound that can be used almost anywhere.

Combining a smartphone app and a handheld transducer attachment the Lumify solution means that patients can be examined at the point-of-care, resulting in faster diagnosis, and the ability to deliver care whenever it’s needed.

General ultrasound devices are heavy and can cost tens of thousands of dollars per unit. They are rarely placed in emergency rooms due to lack of stock or infrequent usage and even less likely to be available in smaller clinics.

Having the image on a touch-screen device is also a huge plus. For conventional ultrasound devices, doctors must use a controller ball to zoom image in and out or for measurement.

But with the image loaded on a tablet, it allows users to intuitively configure it with standard touchscreen gestures that allow for a quicker diagnosis.

“We have been using the Philips Smart Device Ultrasound with our medical students. Leveraging a familiar device with portable diagnostic testing makes learning ultrasound easier for new users and more convenient for experienced imagers. I think that convenience and availability will increase the utility of this technology, improving patient care and efficiency,” says Dr. Bret Nelson, associate professor of Emergency Medicine at Mount Sinai Hospital in New York.

Endoscope-i is another point-of-care solution that was borne out of the desire of two ear, nose and throat (ENT) consultant surgeons to improve the health care they were delivering to their patients.

Similar to clinicians in many fields, endoscopic examinations are used in ENT to both help diagnose medical problems and to survey the progress of disease over time, as they deliver amazingly detailed pictures of clinical findings.

However, the only way to show patients these findings is to use expensive imaging-capturing systems, and even when they are used, the records are on standalone systems and not integrated into electronic care records – reducing the usefulness of the examination.

UK-based digital health company Endoscope-i solves this problem by attaching the endoscope to a smartphone, enabling high-definition imaging straight onto the phone. This allows immediate playback to the patient and secure upload into the clinical record.

More and more, doctors are reaching for their smartphone or tablet during the course of a consultation. Medications, prescribing formularies, clinical decision aids and instructional videos – these are all app-based technologies that are progressively changing the ways in which doctors work and the methods that they use to diagnose us.

Just like we see with the stethoscope, the technologies that are most effective are those that support and enhance the existing workflows of health care professionals, allowing them to improve the way in which they examine their patients and provide a much richer understanding of symptoms and conditions. In turn, this allows them to diagnose and treat patients in much more effective ways.

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